The chief medical officer yesterday reiterated his call for the government to ban smoking in public places, in spite of opposition from the health secretary, but then stopped short of threatening to resign over the issue.

Sir Liam Donaldson pressed for legislation for the second year running, at the launch of his annual report into the state of the nation's health, which focused strongly on two smoking issues - the economic benefits of a ban, and the dramatic way that cigarette use ages the appearance of men and women.

Hitting out at the subtle endorsement of cigarette smoking by models and film stars on screen and in advertisements, he said such publicity was"a highly successful form of deception, linking cigarette smoking to glamour".It "builds up the myth that cigarettes will give young people access to social and sexual enhancement".

Kate Moss, a self-confessed chain-smoker, Britney Spears, Brad Pitt and John Travolta were some of the celebrities who had let themselves be used to promote cigarette smoking, he said.

The selling of cigarettes, suggesting them to be glamorous and empowering, particularly for young women, had gone on since the Virginia Slims campaign in the 1960s, he said, recalling the picture of a good-looking, emancipated young woman smoking and the slogan, "You've come a long way baby". The number of young women taking up smoking today was still rising.

But the idea that smoking could enhance your sexuality was contradicted by the facts, he said. "Smoking destroys your skin. Its principal effect is to degrade collagen, which is the architecture of the skin." It caused damage to very small blood vessels in the face. "The combined effects are to potentially age the skin by as much as 10 to 20 years."

One study in the mid 1990s, in California, showed that, after adjusting for age, weight and sun exposure, women smokers had three times and men twice as much moderately or severely wrinkled facial skin as non-smokers, according to the chief medical officer's report.

A "smoker's face" does exist, it said, and it tends to have crow's feet and a yellow-grey skin tone because damage to blood vessels appears to prevent blushing.

Sir Liam put all his weight behind a ban on smoking in enclosed public places and workplaces, urging that the UK follow the lead of New York, California, some other US states, and Ireland, New Zealand and Norway.

Opinion polls in the UK, questioning both smokers and non-smokers, supported him, he said. Talk of the right of the smoker to smoke was an attempt by the tobacco industry to fend off the feared ban.

Sir Liam said that while on holiday in San Francisco, he asked a young bar worker about the infringement of people's freedom by a smoking ban. Her reply, he said, was powerful: "Your freedom ends where my nose starts."

In New York and California, bars and restaurants were thriving in spite of the smoking ban. Sir Liam produced an economic analysis he had commissioned from the Department of Health to establish the savings from a smoking ban. The experts put the savings, related to absenteeism, and healthcare costs and other benefits, at between £2.3bn and £2.7bn a year.

The health secretary, John Reid, has opposed a ban on smoking in public places, suggesting that for some people in deprived areas, smoking may be the only pleasure left.

Sir Liam said he had talked to Mr Reid a lot about the issue. "I do disagree with him about his reluctance to introduce legislation on smoking, but he has said... his mind remains open. We have a public health white paper in the autumn and I continue to have discussions with him."

Asked whether the ban could be a resignation issue for him, Sir Liam said there would always be issues on a point of principle over which any chief medical officer would resign, He added: "I think you have got to ask yourself... if you lose the odd battle, whether it is better for you to stay on and fight the war."

He pointed out that the NHS had failed with smoking. In October 1992 the Tory government set a target to eliminate smoking from NHS premises by the end of May 1993. More than 10 years later, only 10% of NHS hospitals were entirely smoke free. "This is a terrible example. The NHS should be leading from the front," Sir Liam said.

The chief executive of the King's Fund, Niall Dickson, said that the chief medical officer had made an unanswerable case for a public smoking ban. "The chief medical officer has spoken, now it's time for ministers to listen."

Brent primary care trust had been misleading in saying 67% of people had stopped smoking after a trust course involving nicotine replacement therapy. The authority upheld the complaint of a GP, Stephen Nickless, saying the figure misled those wanting to give up and could be discouraging. The quoted figure was only for people who had reported abstaining from smoking for up to a month, not permanently.

The health of the nation: a diagnosis

· We need to use blood more wisely, according to the CMO. Only 6% of adults donate and the donor pool has declined from 2.1 million in 1999 to 1.64 million this year because of fewer donations from young people and new safety precautions which rule some donors out.

"The gift has to be used both safely and wisely, and at the moment there is a lot of unnecessary use," said Sir Liam. Not only do the blood stocks need to be preserved for when they are really needed, but there are always risks in transfusion. Ten per cent of patients do not wear identifying wristbands, including one in seven of those who are unconscious and cannot identify themselves to ensure they receive the right blood.

· The UK punches above its weight in academic medicine, with 15% of Nobel prizes in physiology or medicine between 1901 and 2003 going to British winners. But there is a shortage of first-class young clinician scientists, who should be the next generation of prize-winners, said Sir Liam.

It is hard for them to combine being a first-class doctor with a first-rate academic researcher, teacher and manager, all at the same time. Something must be done to improve their career structure.

· In the regions, West Midlands has not managed much improvement since last year's report in its rate of late, legal abortions, defined as at more than 13 weeks' gestation. The England average is 12.7%, but the West Midlands is on 16%, with some areas higher.

· In the north-west, risks of death by accidental drowning between 1998 and 2002 were higher than the average in England and Wales. The area includes Morecambe Bay, where the tragedy of the migrant cockle-picker deaths took place, but Ashton, Wigan and Leigh have particularly high risks. The Leeds and Liverpool canal is a problem area, with high accidental and deliberate drownings in the summer and at Christmas, possibly associated with drinking.